Evidence-Based Considerations for RDH Using Aerosol-Generating Devices By Karen Davis, RDH, BSDH
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This virus appears to have stability and viability similar to but somewhat more n unexpected benefit of the SARS-CoV-2 viral significant than another virus (SARS-Cov-1) in experimental conditions2. pandemic for dentistry is the emergence of data Therefore, increased infection control considerations, pre-rinse, increased use shedding light on the safety of utilizing aerosolof High-Volume Evacuation (HVE), and increased use of Personal Protection generating devices on patients during dental hygiene care. Equipment (PPE) should be the new normal for dental professionals. HVE with Many dental hygienists resumed practicing once the shut-down an 8mm opening has been shown to reduce >95% of aerobic bacterial aerosols was lifted with uneasiness about clinician and patient safety when used with ultrasonic and air polishing devices.3 Likewise, recommendations while using aerosol-generating devices such as ultrasonics and air-polishing devices. Some states even passed rules and regulations prohibiting to use low-speed polishing opposed to air polishing with HVE are based upon usage of such equipment for many months, requiring dental assumptions one is safer than the other, yet not substantiated hygienists return to manual instrumentation. The Centers by current evidence. If you were skimping on previous OSHA for Disease Control published recommendations to avoid and CDC guidelines regarding infection control in your "As a practicing dental aerosol-generating devices whenever possible during the dental practices, COVID-19 should have been a wake-up hygienist, I for one, pandemic until mid-2021 when additional language specified call to get your office in order. Thankfully, there are ample was interested in what that the recommendation applied only when working on those resources available from the OSHA, CDC, ADA and ADHA with suspected or confirmed COVID-19.1 Today there are to guide clinicians on how to provide care once patients have the science said about been screened for COVID-19 exposures or symptoms. clinicians that still struggle with concerns over personal and the risks of disease patient safety incorporating aerosol-generating devices, and have continued increased usage of manual instrumentation Patient Preferences and Clinician Experiences transmission during over power instrumentation. the pandemic in lieu Even in a pandemic as devastating and costly as this one, clinicians should still make evidence-based decisions. of such unprecedented Dental professionals accustomed to making evidence-based Evidence-based dentistry encompasses the best available decisions noted early on the lack of scientific data related to recommendations, science and two other important components: the patient’s dental environments and the transmissibility of the SARSrules and regulations preferences and values, and the clinician’s experiences COV-2 virus. As a practicing dental hygienist, I for one, and expertise. Charles Cobb, in his review of the literature was interested in what the science said about the risks of on the profession." presented at the 2000 World Workshop on the topic of disease transmission during the pandemic in lieu of such mechanical therapy4, concluded, “The best results are probably unprecedented recommendations, rules and regulations on obtained by combining sonic/ultrasonic instrumentation the profession. with manual scaling.” This appears to be consistent with current usage of power and manual instrumentation by most clinicians today. Completely eliminating Assumptions Do Not Equate to Science power devices for dental hygiene care may have significant consequences. A study published in 20165 evaluated ultrasonic versus hand instrumentation On March 17, 2020 when the New England Journal of Medicine published data and established that hand and ultrasonic instrumentation can both achieve showing the SARS-CoV-2 virus could remain viable in aerosols for three hours comparable outcomes, but ultrasonic instrumentation reduced the time by 36.6% and on inanimate objects for much longer2, as a dental professional my knee-jerk in one referenced study and caused less soft-tissue trauma.6 Other studies show reaction caused me to immediately question the safety of ever treating patients time savings of 20-50% for thorough periodontal debridement.7,8,9 Said another again. However, at a second glance, I examined how this study was conducted to determine how applicable it is to our dental environment. Suffice it to say, a dental way, eliminating ultrasonic instrumentation could take as much as 50% longer environment already using universal precautions is a stark contrast to creating in a COVID-19 environment. In the absence of incorporating power technology, an aerosolized environment in a laboratory using a three-jet Collision nebulizer are appointments lengthened to accommodate that reality? Will patients need inside of a Goldberg drum. It is a leap to assume results of this laboratory study, to return to complete necessary debridement? Will pathogenic biofilm be where a large expression of viral aerosols was dispersed into a stainless-steel drum, inadequately debrided? These are legitimate questions worthy of consideration. equate to a dental treatment room not being a safe environment to incorporate power technology. Many patients prefer power technology when used with the lowest power and water settings possible and prefer achieving the end result in less time. While not
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16 4th Quarter 2021 mddsdentist.com
